[Burden, trends and gender disparities of alcoholic cardiomyopathy in China from 1990 to 2021].

Objectives: To analyze the burden level, temporal trends, and gender and age disparities of alcoholic cardiomyopathy (ACM) in China from 1990 to 2021. Methods: Data were extracted from the Global Burden of Disease 2021 study database. Core metrics for ACM in China-including prevalent cases, deaths, and disability-adjusted life years (DALYs)-were extracted. The absolute numbers, rates (per 100 000 population), and variation characteristics of the above mentioned disease burden parameters were analyzed by stratification according to age and gender. The Joinpoint regression model was employed to calculate the estimated annual percentage change and average annual percentage change for analyzing the segmented trends of disease burden. Decomposition analyses were conducted to attribute the changes in disease burden to three independent factors: population growth, population aging, and changes in epidemiological rates, so as to quantify the absolute contribution value and relative contribution ratio of each factor to the changes in disease burden. Results: In 2021, the number of prevalent cases of ACM in China was 28 103 (95% uncertainty interval (UI) 22 175-34 991), the number of deaths was 1 861 (95%UI 318-2 987), and the DALYs reached 64 746 person-years (95%UI 12 595-102 876 person-years). The corresponding rates were 1.98 (95%UI 1.56-2.46), 0.13 (95%UI 0.02-0.21), and 4.55 (95%UI 0.89-7.23) per 100 000 population, respectively. The prevalence of ACM in China in 2021 was 4.1-fold of that in 1990, while the mortality and DALYs rates were 3.3-fold and 2.8-fold of those in 1990, respectively. From 1990 to 2021, the average annual percentage change of prevalence, mortality, and DALY rate of ACM were 4.96% (95% confidence interval (CI) 4.67%-5.25%), 3.94% (95%CI 3.63%-4.24%), and 3.65% (95%CI 3.36%-3.93%), respectively, showing an overall trend of initial increase followed by stabilization. Specifically, the annual percentage change peaked at 15.73% (95%CI 14.51%-16.96%) for prevalence during 2000-2004, 8.42% (95%CI 7.89%-8.96%) for mortality during 2004-2011, and 9.80% (95%CI 8.72%-10.89%) for DALYs during 2005-2009. The disease burden exhibited an inverted U-shaped distribution with age. The peaks of case number and prevalence emerged in the 45-54 years age group, whereas the peaks of death number and DALYs occurred in the 50-59 years age group. Across all age groups under 90 years, males bore a higher burden of ACM in terms of prevalence, mortality, and DALYs than females, with the overall prevalence, mortality, and DALY rate being 7.4-fold, 7.7-fold, and 12.1-fold those of females, respectively. Decomposition analysis revealed that epidemiological factors were the primary driver of changes in the burden of ACM in China (contribution ratio: 43.56%-67.17%), followed by population aging (19.98%-33.56%) and population growth (12.84%-22.88%). Conclusions: From 1990 to 2021, the disease burden of ACM in China increased significantly, driven jointly by epidemiological factors, population aging and population growth, with marked disparities in gender and age distribution. Middle-aged and elderly males were identified as the high-burden population. Targeted interventions for alcohol intake, strengthened health management of key populations, and effective implementation of prevention and control policies are urgently required to alleviate the health damage caused by this disease.